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Is It Possible to Make a “Good” Anorexia Movie?

Lily Collins in a scene from To the BonePhoto: Gilles Mingasson / Courtesy of Netflix

Marti Noxon isn’t afraid of criticism. “I’m absolutely down to be challenged, down to have a conversation,” Noxon says, which is good, because the commentary that’s come with her new film, To the Bone, which began streaming on Netflix last Friday, certainly hasn’t all been positive. Since the release of the trailer last month, the anorexia drama starring Lily Collins has engendered criticism from seemingly all corners, though the loudest voices are perhaps from eating disorder survivors who claim that the film effectively works as a relapse trigger.

To the Bone follows Ellen (Collins), a cynical and skeletal 20-year-old college dropout who can’t recall the last time she had her period, and who orchestrates her expulsion from her latest treatment program, exulting in having won a bet with a fellow patient about who’d be booted first. After returning to her comfortable suburban home, her overly solicitous stepmother (Carrie Preston) magically finds her a spot in an unconventional group home run by the sexy, straight-shooting Dr. William Beckham (Keanu Reeves). “The way that you’re going, one day, you won’t wake up,” he tells Ellen when they meet. “And I’m not going to treat you if you’re not interested in living.”

Before shooting a frame of her film, Noxon ran the semi-autobiographical script by eating disorder specialists. The director, who is also the creator of Girlfriends’ Guide to Divorce, and co-creator of UnReal, developed anorexia at age 14, and says she weighed 69 pounds as a high school senior. “We didn’t want to show a whole lot of behavior [and] make it aspirational,” she says of the film. “But we also wanted to tell the story in a way that felt authentic. So it was a tricky balance.”

While Noxon, on the phone from Los Angeles last Friday, acknowledged the difficulty in walking the line between creating a realistic depiction of someone suffering with an eating disorder without offering up what could be misconstrued as a guidebook, Northwestern University psychology professor and body image researcher Renee Engeln, Ph.D., says the movie (which she referred to, disparagingly, as “Lifetime-esque,” in a reference to the cable network) falls firmly into the latter camp.

“We learned all of this info in health class back in the 1990s,” says Engeln, who feels the film offers no new insights into eating disorders, which will plague an estimated 20 million women and 10 million men at some point in their lives. Even worse, Engeln argues, the information it does relay, like its depiction of calorie-counting, secret exercising, weigh-in tricks, and laxative abuse, among other “rexie” rituals, is all likely to be absorbed and abused by the young and impressionable viewers whom the film courts as its audience. To that, Noxon responds: “We didn’t film anything a woman or man who’s already conscientious about their weight wouldn’t already know. The message we’ve been trying to convey is: Look, if you are struggling, or at a place in your recovery where you feel like this could be provocative, it’s a good idea not to watch it.”

Engeln’s bigger concern is the movie might reignite “serious psychological symptoms” in anyone struggling to recover. To that end, Netflix added a disclaimer saying that the film “was created by and with individuals who have struggled with eating disorders, and it includes realistic depictions that may be challenging for some viewers.” But Engeln, who is also the author of Beauty Sick: How the Cultural Obsession With Appearance Hurts Girls and Women, says because Collins looks like a “waifish, glamorized starlet in full eye makeup”—whose character is “sassy, and rebellious, and in many scenes looks like a celebrity or a fashion model”—Ellen is less of a challenge to “thinspiration” than a lure. She points to the film’s graphic closeup of Collins’s ribs, and slow pan on her spine, as the type of content that is often fetishized by pro-ana and “thinspo” devotees.

Noxon says Collins, who has written about her own battle with anorexia in her memoir, Unfiltered, worked with a nutritionist before and after filming. “We were very mindful of her health,” she says. Engeln points to pictures of Collins during filming that showed up on thinspo sites, and wonders if images from the movie will end up there, too. Noxon says the portrayal of Ellen’s body was intended to show the gravity of the illness, and feels it was presented in a way that wasn’t “sensual or beautiful,” but was “in the spirit of trying to help people get help.”

Eating disorder statistics are sobering, and putting Ellen in a group home was Noxon’s way of conveying the range of illnesses and people affected by them. But her detractors say that the patients depicted in the film—including a pony-loving girl with a feeding tube, a black female binger who eats only peanut butter, a miraculously pregnant anorexic on her sixth round of treatment, and an injured anorexic ballet dancer named Luke (Tony winner Alex Sharp) with whom Ellen forms a relationship—weren’t developed enough to learn much. (Noxon’s rebuttal? “It’s not a documentary.”)

Though Engeln praises the film for showing the importance that relationships can play in an anorexic’s recovery, because we meet Luke after he’s substantially improved, we don’t get any understanding of what the disease is like for a man. And while Ellen’s multiple rounds of treatment are realistic and typical, “It isn’t magic, with therapy from a sexy doctor, and one flash of insight,” says Engeln, nor is there any time given to how expensive in-patient treatment is—even for an upper-middle-class woman. Since making the film, Noxon, for her part, has partnered with Project Heal, a nonprofit that provides grants to people afflicted with eating disorders who can’t afford treatment. Project Heal honored the writer/director and her star at their May fundraiser in New York City.

Now that she’s heard all of the critiques, would Noxon do anything differently? “There are a lot of opinions, but there’s no consensus,” she says. All of the experts “have very different takes on what’s good about it, or what’s not good about it”—even her own doctor, on whom Reeves’s character was based. He’s not a fan of group homes, and like Engeln, wanted more therapy included in the plot. “Every expert wants to make a different movie. And every expert thinks that their way of treating the disease would be better than the way that’s shown,” says Noxon. “And that’s only natural because it’s one story. And it’s my story, and it really happened to me.”